Respiratory Tract Infections In Children Research Articles

Genetic Comparison of Human Parainfluenza Virus Type 3 Detected in Respiratory Samples from Patients with Encephalopathy and Airway Inflammation in Aichi Prefecture, Japan.

Human parainfluenza virus type 3 (HPIV-3, human respirovirus 3) is the second most frequently detected virus in lower respiratory tract infections in children after human respiratory syncytial virus (HRSV). HPIV-3, similar to related respiratory viruses such as HRSV and influenza virus, may cause encephalopathy; however, the relevance of HPIV-3 as a pathogenic factor in encephalopathy is unknown. We attempted to detect HPIV-1, HPIV-2, HPIV-3, HPIV-4, HRSV, and human metapneumovirus (HMPV) in 136 patients with encephalitis/encephalopathy or suspected encephalitis/encephalopathy during a 6-year period from 2014 to 2019. HPIV-3 was detected in 6 patients, followed by HRSV in 3 patients. The HPIV-3 strains detected were closely related to those detected in a patient with respiratory disease during the same period. Although HPIV-3 is less widely recognized than HRSV as a triggering virus of encephalopathy, our results suggest that HPIV-3 is as important as HRSV. Surveillance of the causative viruses of encephalopathy, including HPIV-3, would help clarify the causes of encephalopathy in Japan, as the cause is currently reported in less than half of cases in Japan.

Occurrence and management of lower respiratory tract infections in children at a Nigerian tertiary hospital

Objectives Infectious diseases such as pneumonia, diarrhea, and malaria are the major causes of child mortality, with pneumonia, a lower respiratory tract infection (LRTI), being the foremost of the three. Antimicrobial agents are required to treat LRTIs, such as pneumonia caused by bacteria, while those commonly caused by viruses, such as bronchiolitis, do not benefit from antimicrobial therapy unless laboratory tests indicate otherwise. When not shown, empirical management of patients using antimicrobials remains a risk factor for antimicrobial resistance in the management of LRTIs. This study aimed to determine the occurrence of LRTIs in children who presented with acute respiratory tract infections (RTIs) and evaluate their management in comparison with the guidelines. Material and Methods The study was a descriptive retrospective review of prescribing records for respiratory tract infections (RTIs) presented at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA), Ebonyi State, Nigeria. Data were collected through systematic sampling of the case folders of children aged five years and below who presented with RTIs from January to December 2021, using a data collection proforma. Collected data were cleaned and coded, and Statistical Package for Social Sciences (SPSS) Version 28 was used for analysis. Results There were 422 case folders containing diagnoses of RTIs. Of these, 36 (8.5%) were diagnosed with LRTIs and 28 (6.6%) had no comorbidity. Of the 28 cases without comorbidities, pneumonia (20;71.4%) and bronchiolitis (8;28.6%) were the only two LRTIs. Antibiotics were the most prescribed medications, followed by vitamins (8;28.6%) and antihistamines (7;25.0%). There were seven types and three combinations of antibiotic medications, the most being cefuroxime (10;35.7%) followed by amoxicillin/clavulanic acid (7; 25.0%). One case of pneumonia did not receive an antibiotic. Laboratory investigations were not conducted for the majority (25;89.3%) of the cases presented. Conclusion This study showed that the LRTIs presented were mostly managed using the recommended antibiotics for pneumonia. Antibiotics for bronchiolitis without confirmation by laboratory tests may not have been justified as most of them are of viral origin. Deviations from guidelines may be reduced if national protocols are developed in managing LRTIs.

The association between children’s exposure to pesticides and asthma, wheezing, and lower respiratory tract infections. A systematic review and meta-analysis

BackgroundExposure to pesticides is a global public health problem, especially for children. Its association with chronic respiratory disease among children has attracted considerable attention, but the existing evidence remains inconclusive and cannot be certain. Therefore, this systematic review and meta-analysis aim to determine the global pooled effect size of association with pesticide exposure and asthma, wheezing, and respiratory tract infections among children.MethodsA comprehensive search was conducted for relevant literature from electronic databases, including PubMed, Google Scholar, Hinari, Semantic Scholar, and Science Direct. Studies that provided effect size on the association between pesticide exposure and childhood asthma, wheezing, and respiratory tract infections in children were included. The articles were screened, data was extracted, and the quality of each study was assessed with four independent reviewers. Random effects models for significant heterogeneity and fixed effect models for homogeneous studies were conducted to estimate pooled effect sizes with 95% confidence intervals using Comprehensive Meta-Analysis version 3.3.070 and MetaXL version 2. Funnel plot and Higgins I2 statistics were used to determine the heterogeneity of the included studies. Subgroup analyses were computed based on the types of pesticide exposure, study design, sample size category, and outcome assessment technique.ResultA total of 38 articles with 118,303 children less than 18 years of age were included in this meta-analysis. Pesticide exposure among children increased the risk of asthma by 24%; (OR = 1.24, 95% CI: 1.14–1.35) with extreme heterogeneity (I2 = 81%, p < 0.001). Exposure to pesticides increased the odds of developing wheezing among children by 34% (OR = 1.34, 95% CI: 1.14–1.57), with high heterogeneity (I2 = 79%, p < 0.001) and also increased the risk of developing lower respiratory tract infection by 79% (OR = 1.79, 95% CI: 1.45–2.21) with nonsignificant low heterogeneity (I2 = 30%, p-value = 0.18).ConclusionThis meta-analysis provided valuable evidence supporting the association between childhood asthma, wheezing, and lower respiratory tract infection with pesticide exposure. The findings would contribute to a better understanding of the estimate of the effect of pesticide exposure on respiratory health in children and inform evidence-based preventive strategies and public health interventions.

Prescrizione di antibiotici in Pronto Soccorso pediatrico

Background - The emergency department (ED) is an important site of care in which inappropriate antibiotic prescribing and the consequent impact of antibiotic-resistant bacteria can be reduced. Objective - The aim of this retrospective study was to investigate the pattern of antibiotic prescriptions for upper respiratory tract infections in children examined in 3 different ED located in Azienda Ospedaliera Bergamo-Est and to highlight the possibilities for a reduction and a more appropriate use of this class of drugs, overprescribed in paediatric age. Methods - A retrospective observational study was performed on children younger than 18 years of age, who were examined in a general hospital near Bergamo from January 2020 to September 2022. The proportion and type of antibiotic prescription according to demographic, clinical, laboratory and imaging data were determined. Results - 4,731 children were included in the study and 894 (18.9%) received an antibiotic prescription. The prevalence of antibiotic prescription varies with age, with a peak at 1-5 years (21.7%), and depending on the diagnosis, from 2.5 % in children with influenza to 78.4% in children with otitis. Amoxicillin/clavulanate was the most prescribed antibiotic (47% of antibiotic prescriptions), while the percentage of amoxicillin prescription was low (36%). In patients examined for pharyngotonsillitis, amoxicillin was prescribed to 43% of those treated with antibiotics. Conclusions - This study supports the need for a new comprehensive approach to ensure successful antibiotic stewardship. A guide to the use of new diagnostic tests (molecular biology, genome sequencing and immunoenzymatic assays) in a “diagnostic stewardship” perspective may be helpful; however, clinical evaluation remains of fundamental and central importance.

A Retrospective Study on Effectiveness of Antimonium Tartaricum 200 for Respiratory Complaints in Paediatric Age Group

Common upper respiratory tract infections in children are Nasopharyngitis (common cold), Acute tonsillopharyngitis (sore throat) and common lower respiratory tract infections epiglottitis, laryngitis, larygotracheo bronchitis, spasmodic laryngitis, Pneumonia, Bronchiolitis, Bronchial asthma etc. Aim: The study’s objectives are to highlight the incidence of respiratory in kids and identify the effectiveness of Antimonium tartaricum 200 for respiratory complaints in paediatric age group.

Exploring the Preventive Potential of Vitamin D against Respiratory Infections in Preschool-Age Children: A Cross-Sectional Study

Recent studies hypothesized that vitamin D supplementation and subsequent higher 25(OH)D serum levels could protect against respiratory infections in children. This cross-sectional study, conducted from May 2022 to December 2023 in Timisoara, Romania, aimed to evaluate the potential influence of vitamin D supplementation on the incidence of respiratory infections among preschool-age children. This study examined 215 children over 18 months who were split into a group of patients with recurrent respiratory infections (n = 141) and another group of patients with only one respiratory tract infection in the past 12 months (n = 74). Patients were evaluated based on their serum vitamin D levels 25(OH)D, demographic characteristics, and health outcomes. The study identified that preschool-age children with recurrent infections had significantly lower mean vitamin D concentrations (24.5 ng/mL) compared to the control group (29.7 ng/mL, p < 0.001). Additionally, a higher proportion of vitamin D deficiency was observed among children with recurrent infections in the past 12 months. Notably, vitamin D supplementation above 600 IU/week significantly reduced the likelihood of respiratory infections, evidenced by an odds ratio of 0.523 (p < 0.001), indicating that preschool-age children receiving a dose of vitamin D higher than 600 IU/week were about half as likely to experience respiratory infections compared to those who did not. Furthermore, no significant associations were found between sun exposure, daily sunscreen use, and the incidence of respiratory infections. Conclusively, this study underscores the potential role of vitamin D in helping the immune system against respiratory infections in preschool-age children. The observed protective effect of vitamin D supplementation suggests a potential public health strategy to mitigate the incidence of respiratory infections in preschool children on top of the already known benefits.

Determinants of antibiotic prescription in children with adenovirus respiratory tract infections.

We performed this study to evaluate factors associated with antibiotic prescriptions in children with adenovirus infection, since no studies have attempted to address this aspect in the pediatric population.Retrospective study of children younger than 18 years of age tested positive for adenovirus on a syndromic nasopharyngeal test from 2018 to 2023. We compared the need of pediatric intensive care unit (PICU), invasive ventilation, and other respiratory support, viral etiologies, clinical presentations, imaging, and laboratory results in the precovid (2018-2019) and covid (2020-2022) period. The use of antibiotics was studied with multivariable logistic regression including demographic as well as clinical data as covariates.Two hundred fifty-eight patients were enrolled. One hundred fifty-eight patients received an antibiotic (mean duration 6.2 (±2.7) days (median 4; IQR: 4-7)). Presence of seizures and C-reactive protein values as predictors for antibiotic prescription (OR for seizures: 12.17; 95% CI: 1.42-103.91; p = 0.022; OR for CrP: 1.03; 95% CI: 1.01-1.04; p = 0.001). Seventy-four patients received intravenous antibiotics (74/156, 47.4%). Risk factors for intravenous antibiotic were the presence of decay (OR: 3.74; 95% CI: 1.25-11.71; p = 0.018), CrP values (OR: 1.02; 95% CI: 1.00-1.03; p = 0.001), and presence of seizures (OR: 16.34; 95% CI: 2.65-100.83; p = 0.003). Duration of intravenous antibiotics correlated with the presence of seizures (Coeff: 1.6; 95% CI: 0.41-2.89; p = 0.009) even when adjusted for CrP values. Conclusion: The clinical presentation of adenovirus infection in children is non-specific, leading to frequent antibiotic prescription despite bacterial co-infections was rare. Higher CrP values and presenting with seizures are significantly associated with a higher risk of receiving antibiotics. Rapid microbiological tests and newer biomarkers can help clinicians to improve antibiotic prescription in this cohort of children. What is Known: • Adenovirus infection is a common cause of fever and respiratory tract infections in children. • Children with adenovirus infections frequently receive antibiotics, but determinants of this practice are poorly established. What is New: • Higher C-reactive protein values and presenting with seizures are significantly associated with antibiotic prescription. • Since the beginning of COVID-19 and implementation of rapid diagnostics, less children with adenovirus infection received antibiotics.

Lower respiratory tract infections in children with congenital lung abnormalities.

We aimed to determine if the incidence of lower respiratory tract infections (LRTI) among children with asymptomatic, observationally managed congenital lung abnormalities (CLA) differed from that of symptomatic patients who underwent surgery. Second, we sought to compare the pre- and post-resection incidence of LRTI in patients who underwent surgery. This retrospective cohort study included patients born between 1999 and 2021 with CLA confirmed by CT scan who were enrolled in a prospective longitudinal follow-up program. The LRTI incidence rates at 1, 2, 5, 8, and 12 years were compared between surgically and observationally managed patients using incidence rate ratios (IRR). Differences in pre- and post-resection LRTI incidence rates among patients who underwent CLA-related surgery were assessed through IRR. Among 217 included patients, 81 (37%) had undergone surgery and 136 (63%) had been observationally managed. The LRTI incidence rates did not significantly differ at any follow-up moment between the surgical and observational groups. Among the children who underwent CLA-related surgery, the pre-resection LRTI incidence rates were significantly higher than the post-resection LRTI incidence rates (IRR of 3.57, 95% confidence interval: [2.00; 6.33], p < .001). We could not demonstrate differences in LRTI incidence throughout childhood between patients with surgically and observationally managed CLA. We recommend discussing cases of LRTI in patients with CLA in a multidisciplinary setting, using additional diagnostics such as chest X-ray to screen for CLA involvement, enabling a well-considered decision on surgical resection of the lesion.

Where Birth Month, Sex and Age Matters: The Burden of Severe Respiratory Disease in Danish Children

In light of the substantial impact that respiratory diseases in young children poses on healthcare systems globally, and in the wake of the recent COVID-19 pandemic, there is a growing urgency to obtain reliable estimates on the burden of respiratory disease. The aim of this study is to quantify the overall burden of respiratory disease requiring hospitalizations and explore the trends in these admissions in Danish children <5 years, January 1, 2016-October 31, 2022. The number of hospitalizations attributed to respiratory infections in children <5 years, was extracted from the Danish National Patient Register, and stratified into subgroups based on age, gender and birth month, and presented on a month-to-month basis. A total of 48,194 children under the age of 5, were hospitalized due to respiratory infections within the study period and the annual hospitalization incidence exhibited a noteworthy variation. Risk factors associated with the highest hospitalization incidence were young age, male gender and in children under 1-year-old, birth months falling in the period of November to January. Younger age and admission during the winter months were linked to longer hospital stays. The seasonal pattern of hospitalizations and the distribution of hospitalizations across various subgroups were greatly influenced by the COVID-19 pandemic. This study describes and quantifies the importance of factoring in specific child demographics and seasonal variations in hospitalizations when devising preventive healthcare strategies such as the use of monoclonal antibody therapy and vaccines.

Evaluation of serological assays for the diagnosis of childhood tuberculosis disease: a study protocol

BackgroundTuberculosis (TB) poses a major public health challenge, particularly in children. A substantial proportion of children with TB disease remain undetected and unconfirmed. Therefore, there is an urgent need for a highly sensitive point-of-care test. This study aims to assess the performance of serological assays based on various antigen targets and antibody properties in distinguishing children (0–18 years) with TB disease (1) from healthy TB-exposed children, (2) children with non-TB lower respiratory tract infections, and (3) from children with TB infection.MethodsThe study will use biobanked plasma samples collected from three prospective multicentric diagnostic observational studies: the Childhood TB in Switzerland (CITRUS) study, the Pediatric TB Research Network in Spain (pTBred), and the Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infections in children and adolescents (ProPAED) study. Included are children diagnosed with TB disease or infection, healthy TB-exposed children, and sick children with non-TB lower respiratory tract infection. Serological multiplex assays will be performed to identify M. tuberculosis antigen-specific antibody features, including isotypes, subclasses, Fc receptor (FcR) binding, and IgG glycosylation.DiscussionThe findings from this study will help to design serological assays for diagnosing TB disease in children. Importantly, those assays could easily be developed as low-cost point-of-care tests, thereby offering a potential solution for resource-constrained settings.ClinicalTrials.gov IdentifierNCT03044509.

Differences between parents' and paediatricians' perceptions of mild respiratory infections in childhood: contrast study.

Mild respiratory infections are a common reason for consultation in paediatrics, both in the emergency department and in primary care clinics. These conditions, mostly viral and self-limiting, have a significant impact on the healthcare system, school and work absenteeism, and family routines. Despite being common and banal illnesses from a medical perspective, they involve a significant concern in families. The main objective of the contrast study was to compare the perceptions of parents and paediatricians regarding mild respiratory infections in childhood and their impact on family conciliation. Two online, cross-sectional surveys were conducted among Spanish paediatricians and parents with children aged 6 months to 12 years, involving 504 paediatricians and 1,447 families, with questions on attitudes towards visits to the paediatric consultation, care burden of minor pathologies, work, and family conciliation, and treatment and prevention of these illnesses. Results showed significant differences in paediatricians' and parents' perceptions in many aspects. According to 34.5% of paediatricians and 27% of parents, families regularly go to the paediatrician without a scheduled visit. Only 4% of parents report having self-medicated their child, while paediatricians raise this percentage significantly to 48%. Regarding the question: "it is normal for a child to have an average of 4 colds a year," only 25.5% of the surveyed families "strongly agree" unlike to 70.2% of paediatricians. 72.8% of paediatricians "strongly agree" with: "in my opinion, it is good for children to get sick to improve their immune system" reduced to 45.9% of parents. Consultations for minor pathologies represent a "high workload" for 60.9% of paediatricians, while this opinion is agreed by only 18.9% of the parents. Mild respiratory infections in childhood are perceived differently by paediatricians and parents. While paediatricians perceive them as a common and manageable phenomenon, parents tend to show higher concern and demand for medical attention. This study underlines the need to improve communication between paediatricians and parents to align perceptions, optimise the use of the health system resources, and improve the efficiency in the management of these common paediatric illnesses.

Using targeted second-generation sequencing technique to guide clinical diagnosis and the effect of medication on the therapeutic effect and prognosis of respiratory tract infection in children: An observational study.

To explore the effect of targeted second-generation sequencing technique to guide clinical diagnosis and medication on the therapeutic effect and prognosis of respiratory tract infection (RTI) in children. During January 2021 to June 2022, 320 children with RTI cured were selected in our hospital as the object of this retrospective study. The control group accepted empirical broad-spectrum antibacterial therapy and the observation group accepted targeted second-generation sequencing technique to guide diagnosis and medication. The therapeutic effect, improvement time of clinical symptom index, laboratory-related index, level of inflammatory factors, incidence of complications, and parents' treatment satisfaction were compared. The observation group was considerably more efficacious (91.25%) versus the controlled group (72.50%). The duration of enhancement of fever, nasal congestion, tonsillar congestion, and cough symptoms was shorter in the observation group (P < .05). Serum levels of iron, IgA, IgG as well as IgM were substantially elevated in the observation group. The levels of IL-4 and IL-10 were markedly reduced in the observation group after treatment. The prevalence of complications was considerably below that of the comparison group (21.25%) in the observation group (8.75%). Parental satisfaction with therapy was markedly higher in the observation group (92.50%) than in the control group (66.25%). The application of targeted second-generation sequencing technology to guide clinical diagnosis and drug use can elevate the RTIs efficacy and prognosis in childhood. Targeted second-generation sequencing can achieve precise treatment, reduce drug resistance of drug-resistant strains, and improve the efficacy. It has high promotion and application value.

Xuanfei Formula inhibited RSV infection by normalizing the SREBP2-mediated cholesterol synthesis process.

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infections in children and the elderly, often progressing to pneumonia and severe sequelae. However, there are currently no feasible and cost-effective interventions with proven efficacy for children, making medications with anti-RSV activity urgently needed. Traditional Chinese medicine has shown promising therapeutic efficacy in alleviating viral infection symptoms. Therefore, we aimed to develop effective strategies for RSV treatment based on traditional Chinese medicine. The infection status was assessed in BALB/c mice with or without Xuanfei Formula (XFF) treatment over a one-week period using H&E staining, cytokine assays and RSV titer testing after RSV challenge. Remarkably, on the first day of XFF intervention, both the pro-inflammation cytokine levels in the serum and RSV-N gene copies in the lung of mice were plummeted, compared to the RSV-infected group. This implied that XFF might possess the immune-independent anti-RSV capability. To elucidate the underlying mechanism, we employed transcriptome analysis followed by k-means analysis. The reversal effects of XFF against RSV primarily focused on the processes of innate and adaptive immunity. Additionally, we found that XFF administration corrected the disordered fatty acid and cholesterol metabolism processes during RSV infection. Lipidomics profiling indicated consistent cholesterol abundance with transcriptional changes but not fatty acids. Cholesterol synthesis-related genes mRNA levels and cholesterol synthesis intermediates detection supported XFF's repression upon cholesterol biosynthesis. Aberrantly increased cholesterol production has been reported as necessary for RSV infection. To mimic that, we observed lovastatin treatment inhibited RSV replication and pro-inflammation cytokine expression in vitro. Transcription factor prediction of differentially expressed genes (DEGs) involved in cholesterol synthesis implicated SREBP2. Through network pharmacology, stigmasterol and β-sitosterol were identified as the effective active ingredients within the XFF, with the help of further molecular docking and mass spectrum detection. In vitro experiments demonstrated β-sitosterol and stigmasterol reinforced the bonding between SREBP cleavage-activation protein (SCAP) and insulin-induced gene proteins (INSIGs) to inhibit SREBP2 cleavage maturation and consequent RSV infection. Xuanfei Formula (XFF) exhibits excellent anti-RSV efficacy by inhibiting SREBP2-mediated cholesterol synthesis to reduce RSV replication and ameliorate inflammation in the lung of infected mice.

The efficacy of Nigella sativa oil in the prophylaxis and treatment of upper respiratory tract infections in children

The aim of this study was to investigate the efficacy of Nigella sativa oil (NSO) in pediatric Upper Respiratory Tract Infections (URTI). 230 pediatric URTI patients who were consecutively admitted to Family Medicine Outpatient Clinic between 05/12/2022 and 05/09/2023 whose parents agreed to participate were enrolled. Examinations were completed with 110 cases who were orally consuming standardized NSO exclusively, while 120 controls used no phytotherapeutics. Relationships of categorical variables were analysed by Chi-square. Group comparisons of continuous variables were performed with either t-test or Mann-Whitney U test, depending on the normality of distribution. Time-dependent differences in continuous variables between groups were analyzed by rANOVA. Generally accepted significance was p < 0.05. There were 230 cases, 108 boys and 122 girls. The mean age was 10.76 ± 3.75 years. The case and control groups were similar (p > 0.05) in terms of age and gender. At first follow-up, severity scores (p < 0.001) and prevalence of antibiotic use (p < 0.001) were significantly lower in cases compared to controls. Prevalence of visits with URTI and severity scores were significantly reduced at the 2nd follow-up (both p < 0.001). Time-dependent changes in all outcome measures were significantly in favor of cases (p < 0.001 for all).This study showed that severity score, prevalence of antibiotic use and visits with URTI decreased with oral NSO use. This study supports the existing evidence that natural products are promising alternative treatments with their safety and versatility and hopefully may promote further research on appropriate dosage, safety and efficacy of these drugs for evidence based and safe complementary treatments.

Activation of the NLRP3 inflammasome by human adenovirus type 7 L4 100-kilodalton protein.

Human adenovirus type 7 (HAdV-7) is a significant viral pathogen that causes respiratory infections in children. Currently, there are no specific antiviral drugs or vaccines for children targeting HAdV-7, and the mechanisms of its pathogenesis remain unclear. The NLRP3 inflammasome-driven inflammatory cascade plays a crucial role in the host's antiviral immunity. Our previous study demonstrated that HAdV-7 infection activates the NLRP3 inflammasome. Building upon this finding, our current study has identified the L4 100 kDa protein encoded by HAdV-7 as the primary viral component responsible for NLRP3 inflammasome activation. By utilizing techniques such as co-immunoprecipitation, we have confirmed that the 100 kDa protein interacts with the NLRP3 protein and facilitates the assembly of the NLRP3 inflammasome by binding specifically to the NACHT and LRR domains of NLRP3. These insights offer a deeper understanding of HAdV-7 pathogenesis and contribute to the development of novel antiviral therapies.

Longitudinal microbiome changes in children exposed to proton pump inhibitors.

Proton pump inhibitor (PPI) use has been associated with an increased risk of gastrointestinal and upper respiratory infections in children. There are limited longitudinal data on the effect of PPI in children. The goal of this prospective observational study was to compare the stool and oropharyngeal microbiome of children before and after starting PPIs. We prospectively recruited participants from a gastroenterology clinic. Consented pariticpants provided stool samples and oropharyngeal swabs at baseline and after eight weeks of PPI therapy. Microbiome changes were measured by analyzing 16S sequencing from both body sites at both timepoints. Thirty-four participants completed the study and provided samples both at baseline and after eight weeks on PPI therapy. Of those, 24 participants had sufficient sequencing from both stool and oropharyngeal samples at both time points. There were no differences between the pre- vs post-PPI samples using beta-diversity metrics in either the oropharynx or stool. There were, however, significant changes in specific taxa. There was an enrichment of Streptococcus in the stool in after PPI-use and a reduction in the relative abundance of Bifidobacterium, Peptostreptococcus and Turicibacter (p-values < 0.01). Furthermore, there was an increase in the relative abundance of oropharyngeal bacteria in the stool after PPI therapy. This enrichment of oropharyngeal bacteria in the stool was most prominent in younger participants. Further investigation is needed to determine the clinical and microbial factors that predispose or protect against microbiome changes due to PPI-use, and why young children are more susceptible to this PPI effect.

Epidemiological changes of acute respiratory infections in children: A single-center experience after COVID-19 lockdown.

Since the start of the COVID-19 pandemic, the epidemiology of acute respiratory infections (ARIs) has continually changed, making it difficult to predict. Our study aimed to evaluate epidemiological changes and clinical outcomes of ARIs in pediatric patients in the post-lockdown period. A single-center retrospective cross-sectional study was performed in one of the largest pediatric emergency departments in Lithuania during two cold seasons-from October 1, 2021, to April 30, 2022 (Season I) and in the same period in 2022-2023 (Season II). Patients under 18 years of age who had been tested for COVID-19 were enrolled in the study. Additional data about other respiratory pathogens in the study group (specifically influenza A/B, respiratory syncytial virus (RSV) and group A Streptococcus (GAS)), were included. During both seasons of our study, 19,366 children were screened for COVID-19. Positive tests for COVID-19 decreased from 14.5% in Season I to 5.9% in Season II, while at the same time, the rates of other infections increased significantly: influenza from 17.5% to 27.1%, RSV from 8.8% to 27.6%, and GAS from 8.4% to 44%, respectively. In Season II, COVID-19 infection presented in fewer admissions to pediatric intensive care (0.8% vs. 3.7%, p<0.01) and there were no deaths, while influenza presented in a higher proportion of hospitalizations (10.5% vs. 6.1%, p<0.01) and there was one death. The proportion of RSV hospitalizations also increased in Season II (34.6% vs. 44.0%, p<0.01). The early post-lockdown period saw a decline of COVID-19 and re-emergence of influenza, RSV and GAS infections in children. In Season II, COVID-19 cases became milder contrary to influenza. RSV infection contributed significantly to hospitalizations for respiratory infections in children in both seasons, particularly in Season II. Coinfections were not associated with a more severe course of the disease.

RSV Disease Burden in Primary Care in Italy: A Multi-Region Pediatric Study, Winter Season 2022-2023.

Human respiratory syncytial virus (RSV) is one of the most frequent causes of respiratory infections in children under 5 years of age, but its socioeconomic impact and burden in primary care settings is still little studied. During the 2022/2023 winter season, 55 pediatricians from five Italian regions participated in our community-based study. They collected a nasal swab for RSV molecular test from 650 patients under the age of 5 with acute respiratory infections (ARIs) and performed a baseline questionnaire. The clinical and socioeconomic burden of RSV disease in primary care was evaluated by two follow-up questionnaires completed by the parents of positive children on Days 14 and 30. RSV laboratory-confirmed cases were 37.8% of the total recruited ARI cases, with RSV subtype B accounting for the majority (65.4%) of RSV-positive swabs. RSV-positive children were younger than RSV-negative ones (median 12.5 vs. 16.5 months). The mean duration of symptoms for all children infected by RSV was 11.47 ± 6.27 days. We did not observe substantial differences in clinical severity between the two RSV subtypes, but RSV-A positive patients required more additional pediatric examinations than RSV-B cases. The socioeconomic impact of RSV infection was considerable, causing 53% of children to be absent from school, 46% of parents to lose working days, and 25% of families to incur extra costs. Our findings describe a baseline of the RSV disease burden in primary care in Italy before the introduction of upcoming immunization strategies.

The Relationship between Exclusive Breastfeeding and the Incidence of Acute Respiratory Tract Infection in Children Under Five in Muna Regency Southeast Sulawesi Province

Backgrounds: Data obtained from the Muna District Health Service shows that there are still many toddlers affected by acute respiratory infections and each year this increases. In 2019 there were 3778 cases (23.7%), in 2020 there were 2500 cases (12.2%), while in 2021 there were 3868 cases (24.2%). The aim of this research is to analyze the relationship between giving exclusive breast milk and the incidence of acute respiratory infections in toddlers in Muna Regency, Southeast Sulawesi Province.&#x0D; Methods: This type of research is quantitative observational using a Cross Sectional Study design. This research was carried out in July 2022. The research population was all toddlers in Muna Regency, totaling 3868 people and a sample of 97 people obtained using proportional simple random sampling. Data were processed using the chi-square test, closeness test and phi test.&#x0D; Results: The research results showed that the results of the chi-square test on the variable giving exclusive breast milk obtained a p value of 0.000. This shows that H0 is rejected and Ha is accepted, meaning that there is a moderate relationship between exclusive breastfeeding and the eventAcute respiratory infectionsamong toddlers in Muna Regency, Southeast Sulawesi Province.&#x0D; Conclusion: There is a connection between giving exclusive breast milk and the incident Acute respiratory infectionsamong toddlers in Muna Regency, Southeast Sulawesi Province. It is hoped that mothers can provide knowledge about the factors related to the occurrence of acute respiratory infections in toddlers.

“You can feel the fresh air … ” Rural Alaska Native household perceptions of home air purifiers and health

ABSTRACT Alaska Native and American Indian children experience frequent respiratory illness. Indoor air quality is associated with the severity and frequency of respiratory infections in children. High efficiency particulate air (HEPA) purifiers effectively improve indoor air quality and may protect respiratory health. In 2019, the Yukon-Kuskokwim Health Corporation implemented a pilot programme that provided education and HEPA purifiers to households of children with chronic lung conditions. The team evaluated HEPA purifier acceptability and use by interviewing representatives from 11 households that participated in the pilot programme. All interviewees reported improvement in their child’s health, and some believed that the health of other household members was also improved because of the HEPA purifier. Interviewees reported that the HEPA purifiers were easy to use, quiet, and not expensive to run. Five of 11 households were still using the HEPA purifier at the time of the interview, which was about three years after receipt of the unit. The most common reasons for discontinuing use were equipment failure and lack of replacement filter, suggesting that programme support could increase sustainability. Our evaluation suggests that HEPA purifiers are acceptable and feasible for use in rural Alaska Native households.